Objectives: Carotid artery disease is one of the important factors of neurological complications after cardiac surgery. In this study we present our surgical experience and discuss its implication for patients with carotid and cardiac disease. Methods: Five patients underwent combined carotid endarterectomy (CEA)/cardiac surgery including thoracic aortic repair. There were three male and two female patients, with a mean age of 67±10 years (range, 54-75 years). All patients had an 80% or greater stenosis in the unilateral internal carotid artery. Three patients had coronary artery disease and underwent combined CEA/off-pump coronary artery bypass grafting (OPCAB). One patient had an aortic valve stenosis (AS) with repeated syncope and chest pain, and underwent combined CEA/aortic valve replacement. The remaining patient had an extremely large aortic arch aneurysm (90 mm) and underwent combined CEA/total arch replacement. Results: There were no surgical or hospital deaths. No perioperative complications including myocardial infarction and stroke occurred. During the follow-up period, lasting from 2 months to 27 months (mean, 13 months), there were no late deaths, neurological complications nor cardiac events. Conclusions: Combined CEA/cardiac surgery offered an acceptable morbidity in these complex patients. Due to the preliminary nature of our study, further follow-up and experience with our management strategy are necessary. (Ann Thorac Cardiovasc Surg 2003; 9: 180-183)